We were taught, we currently teach, and most of us believe that clinical decisions can be made on the basis of understanding the pathophysiology of diseases, logic, trial and error, and nonsystematic observation.1 As a result, the majority of the funding for research about skin disease is devoted to the basic sciences of skin physiology and pathophysiology. Much of clinical training of residents is an "apprenticeship" model in which they learn to do what the attending dermatologist does, and what the attending does is based on logical deductions, personal experience, and nonsystematic observations. Last, the certifying board examination tests skin physiology and pathophysiology, pattern recognition, and accepted "standards of care." Very little funding goes to clinical research. Basic clinical epidemiology is absent from the curricula of most dermatology training programs. Dermatology residents do not have to demonstrate competence in basic clinical decision-making skills to become board certified. Perhaps the dawning of the 21st century is a good time to reexamine our paradigm for learning, teaching, and certifying in dermatology.
Bigby M. Paradigm Lost. Arch Dermatol. 2000;136(1):26-27. doi:10.1001/archderm.136.1.26